Growth Hormone Adenoma / Acromegaly

A 52 year-old man complains of increased hat size and headaches when he wakes up in the morning. Physical exam reveals mild diastolic hypertension, prominant jaw with spaces between the teeth, large hands and feet, and generalized muscle weakness.

Introduction

Benign pituitary adenomathat releases excess growth hormone

GH stimulates release ofinsulin growth-like factor 1

Gigantism if the condition occurs before the fusion of the epiphysis

Acromegaly if it occurs after skeletal epiphyseal closure

Presentation

Symptoms

generalized enlargement of bone and soft tissue

large hands and feet

frontal bossing

leads to increased hat size

space between teeth

jaw grows but teeth remain the same size

macroglossia

carpal tunnel syndrome

size of median nerve increases due to edema

Physical exam

HTN

due to the anti-naturiuretic action of GH

Evaluation

Photographic changes

for acromegalic features examine an old photograph to reveal changes in facial bones

Serology

↑ IGF-1

more sensitive test because the level is more constant than the pulsatile release of GH

hyperglycemia

due to gluconeogenic action of GH

Suppression tests

GH release not suppressed by glucose challenge

MRI/CT

shows enlargement of sella turcica on imaging

Cardiomegaly on CXR

hypertrophy of left ventricle

Treatment

Surgical

transphenoidal surgery

Medical

octreotide (somatostatin analogue)

supresses GH release

dopamine analog

second line for refractory tumors

GH receptor antagonists

pegvisomant

Prognosis, Prevention, and Complications

Cardiomegaly progressing to CHF is the most common cause of death

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